Sonoma County Business Leads Club

Confidential Application:
please fill out this form and bring it to a meeting. Any questions, please call the president, Barbara Larsn at (707) 291-1344

Name: _________________________________ Date: __________________

Name of Business: __________________________________________________

Type of Business: __________________________________________________

Address of Business: _______________________________________________

Business Phone:________________________Business Fax:___________________

Home Phone:__________________________Age of Business:________________

Social Security or Tax ID Number: ___________________________________

E-Mail: _________________________ Website: ________________________

THE ABOVE-NAMED INDIVIDUAL GIVES EXPRESS PERMISSION FOR THE TIPSTERS
TO RUN A CREDIT REPORT IN ORDER TO REVIEW APPLICANT’S WORTHINESS FOR MEMBERSHIP.

Signature:__________________________________

Please provide The Tipsters with two professional references:

Name:_____________________________Phone:__________________________

Name:_____________________________Phone:___________________________

Please suggest two new businesses which would likely join The Tipsters:

Name:_____________________________Phone No:________________________